Prostacyclin Usage for Spinal Cord Protection During Experimental Thoracic Aortic Cross-Clamping

Abstract

The risk of paraplegia associated with thoracic aortic cross-clamping is high even when various methods of spinal cord protection are used. In this study prostacyclin 12 (PGI2) was selected as an agent to reduce the spinal cord injury because of its vasodilator, antiaggregant, and cytoprotective properties.Twelve dogs underwent sixty-minute aortic occlusion. Six dogs received PGI2 whereas the other 6 did not (controls). PG12 administration was started at a rate of 5 ng/kg/minute five minutes before aortic occlusion. This dosage was increased to 25 ng/kg/minute during aortic occlusion. PGI2 at a dosage of 5 ng/kg/minute was maintained for a period of five minutes after the aortic occlusion was released.Three dogs in the control group were paraplegic. There were no paraplegic dogs in the PGI2 group. Distal aortic perfusion pressure was 31 ±6 mmHg in the PGI2 group and 22 ±3 in the control group (P < 0.008).As a result of this study the authors conclude that PGI2 is a valuable agent for decreasing the risk of spinal cord injury during thoracic aortic cross-clamping lasting sixty minutes.

Functional Outcome in Model of Spinal Cord Ischemia: Use of Enoximone

“…11 We have also demonstrated that prostacyclin can reduce the risk of spinal cord injury. 3,4 These drugs increase the spinal cord blood flow, whereas sodium nitroprusside used as a vasodilator lowered spinal cord perfusion pressure and increased the risk of neurologic injury. 12 It is our belief that any vasodilator that increases cyclic adenosine monophosphate levels, reduces the incidence of neuro-logical injury.…”

“…1,2 Various methods such as pharmacological agents and shunt procedures have been used to protect the spinal cord from ischemia but none have been uniformly successful. [3][4][5][6][7] The aim of these techniques is either to increase the spinal cord blood flow or to reduce the risk of ischemia-reperfusion injury. Papaverine has been shown to significantly increase spinal cord blood flow.…”

“…7 Prosta-cyclin, a drug similar to papaverine, reduced the risk of spinal cord injury in previous studies by our group. 3,4 In this study, we selected enoximone to maintain blood flow in the spinal cord during aortic crossclamping because enoximone has both inotropic and vasodilating properties similar to papaverine.…”

Enoximone Usage for Experimental Spinal Cord Protection During Aortic Cross-Clamping

“…In a previous study, papaverine was used as a drug to increase the spinal cord blood flow because it reverses the basilar artery spasm induced by subarachnoid hemorrhage (10). We also demonstrated that prostacyclin can reduce the risk of spinal cord injury (4,5). Both of these drugs increase the spinal cord blood flow.…”